Case Study

Southport and Formby Health is a GP owned provider organisation which was created to enhance the delivery of healthcare services to people living in Southport and Formby. We are comprised of 11 member practices and provide care to over 125,000 patients in the area.

Our services are provided locally, meaning fewer visits to large, busy hospitals and faster treatment in often a more convenient location for patients.

Our flagship service is our extended GP access service which is called the 7-Day GP service. The 7-Day GP service has been operational since October 2018 providing access to primary care in the evenings and weekends.

Our 7-Day GP service offers a range of services including:

• GP consultations
• Advanced Nurse Practitioner consultations
• Mental Health Specialist Nurse consultations
• Physiotherapy telephone triage and face-to-face appointments
• Practice nurse appointments
• Asthma checks
• Diabetes checks
• Hypertension/blood pressure checks
• Cervical screening tests
• Blood tests
• Electrocardiograms (ECGs)
• Ear syringing

In October 2022 there was a change in how all extended access services were commissioned and there was a change in commissioner and now the Primary Care Network was responsible for commissioning the service. The PCN were impressed at how the service has operated over the previous four years that they asked Southport and Formby Health to continue providing the service.

As an organisation, we decided embark on a project that would examine elements that would tell us how effective the service was working, what elements of the service we needed to change and to gain meaningful feedback from patients.

This was a substantial change in how we collected and used data regarding the service. It was an innovative approach designed to give meaningful data and feedback about the 7-Day GP service.

Leadership-This initiative was a collaborative approach led by the 7-Day GP service manager and Southport and Formby Health directors.

Outcomes and Sustainability-The outcomes achieved from this initiative were used to determine the number of patients seen monthly, increase appointment utilisation and gain patient feedback about the service. This data which was provided monthly meant we could adapt the service quickly and be responsive to practices and patients’ needs.

Involvement and Inclusion-This initiative involved the 7-Day GP service team and we have widened the initiative to involve external stakeholders such as HealthWatch Sefton and community Patient Participation Groups (PPG).

Transferability and Dissemination-This initiative has been shared across our organisation as the gold-standard in the way we report on our service. The initiative will also be shared with other extended access services as there is no national reporting metrics for extended access services.

We were aiming to increase appointment utilisation fairly across all practices, increase patient experience feedback and we wanted to make sure we were providing GP appointments accessible to everybody. To achieve this, we firstly needed to understand who our services users were and what they said about us.

Understanding GP Practices-Our 7-Day GP Service management team worked with each practice individually. We noticed differences between each practice and how they utilised appointments. We provided each practice with a bespoke training package. We completed face-to-face receptionist training, education on what the service offers, created and supplied training materials . We identified some practices utilised more appointments than others which would mean patients were not given an equal opportunity to access the service.

New and improved reports were introduced to enable the team to identify:

• Total utilisation by each member practice
• Utilised booked appointments by practice and clinician type
• Fair usage of appointments per practice by number of patient population

The result of changing our monthly reports meant that we can now see where practices may need encouragement or support. We identified practices who are ‘overusing’ the service and may need education on fair usage. The team have built a good rapport with practices, so these conversations are done in a sensitive and supportive manner.

Increasing Patient Experience-We acknowledged that our patient feedback could be improved.  We wanted to see our feedback in ‘real time’ and be proactive with making changes.

We did this by:

• Embedding a robust patient feedback process
• All patients receive a feedback text following appointment
• Feedback is reviewed the next working day
• Named staff are informed of feedback in a timelier manner
• Negative feedback is actioned upon in a timelier manner
• Data is extracted into more meaningful reports

The 7-Day GP Service management team consisted of a Clinical Director, Service Manager and three Senior Administration staff. All staff have worked collaboratively in the planning and delivery of this project.

The Clinical Director provided a link direct to the Board and highlighted the need for more in-depth insight into the service by way of more detailed reporting. Existing reports were not informative and accurate enough to make change. It was important to gain an accurate reflection of the service. Through support from the Clinical Director reports were updated and made more meaningful. The reports were created and designed around the contractual requirements and what was felt was necessary for the service to function optimally.

The 7-Day GP service manager used the data from reports to identify areas which required improvement. A good relationship was built with the practices by the service manager. A patient experience feedback process was embedded, and staff were supported with training provided by the senior administration staff. Data was monitored closely and staff not following the process were quickly identified and supported with additional training.

The 7-Day GP Service management team increased patient knowledge and education by working with other community groups and local services including-

• Healthwatch
• McMillan Cancer Support
• Local council
• Southport & Formby Primary Care Network

We looked at the following areas:

Service hours provided each week-Our new reports allow us to forecast hours and add additional clinics to adhere to contractual requirements.

Number of appointments provided by clinician type-This was a new metric that we looked at for analysing how our service operates.  This has been invaluable when we look at the proportion of clinician types from our service. We are aware that to have a versatile and varied service we need to have a mix of all clinicians.

Practice utilisation of the service & Practice utilisation per clinician type-This was a useful piece of information to ensure that all practices were using the service to meet the needs of all patients. We can see the total number of booked appointments each month along with the patients that did not attend (DNA) from each practice. It is useful to look at this metric over a 6-month period and the data suggests that practices’ use monthly varies but all practices seem to be getting an equal usage of the service over a longer period.

Patient feedback-We acknowledged that our patient feedback could be improved. We also wanted our data to be more meaningful so that we could gain a true Insight into how the service operates and make any necessary changes to improve the service for practices and patients.

The reports below show snapshots of our monthly reports.

The key findings are: 

• Increased number of patient feedback responses. We now send a text patient survey to every patient that visits the service, and this is the reason that our number of responses has increased. This feedback is invaluable to the service. The feedback is positive with most patients either extremely likely or likely to recommend the service 
• The feedback is specific to each appointment and each clinician type. We ask the patient which clinician type they saw or what procedure they underwent e.g. Electrocardiogram, ear syringing. We then know what appointment the feedback relates to, Overall, the feedback is extremely positive, and we can then feedback individual comments to individual clinicians. Clinicians have found this highly motivating, and a number have remarked that they will use the comments for appraisals. Conversely if any of the comments or feedback is negative or concerning, again we know what appointment type or clinician type the feedback relates to.  

Each individual GP Practice now has a named 7-Day GP Service representative assigned to them. Through this offer the representative acts as a direct link for each practice and can assist with staff training, dealing with any queries regarding the service and help with practice engagement. The process of working closely with practices has led us to know that some staff have found the appointment booking system complicated and time consuming, which made them less likely to offer an appointment with the service. We have looked at different ways for practices to book appointments and we are excited to introduce a new way for them to book appointments. This new process simplifies patient access and further strengthens the relationship between practices and the service. The service intends to continue its work in the community by attending regular Healthwatch Committee Meetings, health and wellbeing events, local community PPGs and working closely with the Primary Care Network. This will provide support and education to service users about how to access the service in the future.

We wanted our service to be responsive, proactive and accessible to all. We could not achieve this without these key elements-

• A unified approach to driving improvement and positive change
• Collaborative working and engagement
• Nurturing a ‘patient-centred’ culture
• A supportive and passionate team

The outcomes from the changes we have made are measurable in our reports, but also by our positive feedback direct from patients. We have made GP appointments more accessible to patients in Southport and Formby. We have made the changes that patients and practices have wanted, which overall, has made this initiative a success.

• Identify an area you wish to improve and which you can measure progress.
  Have a realistic achievable goal.
• Involve patients, GP practices and other stakeholders in any change initiative.
• Be patient and work as a team to overcome obstacles.
• Share updates and outcomes to keep momentum with your project team.
• Share best practice widely.